Missing Credit Card Receipt Form
This form must be completed and submitted within 3 business days of identifying a missing receipt for a purchase made using a school-issued credit card. Failure to submit this form may result in the loss of purchasing privileges.
Card Holder Name
*
First Name
Last Name
Last 4 Digits of Card:
*
Campus
*
Please Select
Capital Region
Northshore
Caddo
Ruston
CMO
DRC
Department
*
Please Select
Academics
Operations
SPED
Business/Finance
Board
Reason for Missing Receipt
*
Please Select
Misplaced
Not Provided by Vendor
Vendor
*
Vendor Address
Vendor Email
Vendor Phone Number
Purpose of Purchase
*
Items Purchased
*
Date of Purchase
*
-
Month
-
Day
Year
Expense Detail
Expenses List
*
Rows
GL
Description
Quantity
Unit Price
Total
1
Building Improvements
Education and Certification Reimbursement
Machinery and Equipment
Other Employee Benefits
Professional Fees
Technical Services
Professional Services
Administrative Services
Education Services
Legal Services
Consultants
DRC
Safety
Utilities Expense
Custodial Expense
Repairs and Maintenance
Bldg Rental/Lease
Rental of Equipment or Vehicles
Field Trips
Telephone
Advertising and Marketing
Food Costs
Mileage Allowance
Travel
Temporarily Restricted Expenses
Materials and Supplies
Materials and Supplies Textbooks
Materials and Supplies Assessments
Materials and Supplies Curriculum
Materials and Supplies Writing
Books and Periodicals
Office Supplies
Equipment
Dues & Fees
Meals and Entertainment
Miscellaneous Expense
Bank Fees
Other Misc Business Expense
2
Building Improvements
Education and Certification Reimbursement
Machinery and Equipment
Other Employee Benefits
Professional Fees
Technical Services
Professional Services
Administrative Services
Education Services
Legal Services
Consultants
DRC
Safety
Utilities Expense
Custodial Expense
Repairs and Maintenance
Bldg Rental/Lease
Rental of Equipment or Vehicles
Field Trips
Telephone
Advertising and Marketing
Food Costs
Mileage Allowance
Travel
Temporarily Restricted Expenses
Materials and Supplies
Materials and Supplies Textbooks
Materials and Supplies Assessments
Materials and Supplies Curriculum
Materials and Supplies Writing
Books and Periodicals
Office Supplies
Equipment
Dues & Fees
Meals and Entertainment
Miscellaneous Expense
Bank Fees
Other Misc Business Expense
3
Building Improvements
Education and Certification Reimbursement
Machinery and Equipment
Other Employee Benefits
Professional Fees
Technical Services
Professional Services
Administrative Services
Education Services
Legal Services
Consultants
DRC
Safety
Utilities Expense
Custodial Expense
Repairs and Maintenance
Bldg Rental/Lease
Rental of Equipment or Vehicles
Field Trips
Telephone
Advertising and Marketing
Food Costs
Mileage Allowance
Travel
Temporarily Restricted Expenses
Materials and Supplies
Materials and Supplies Textbooks
Materials and Supplies Assessments
Materials and Supplies Curriculum
Materials and Supplies Writing
Books and Periodicals
Office Supplies
Equipment
Dues & Fees
Meals and Entertainment
Miscellaneous Expense
Bank Fees
Other Misc Business Expense
4
Building Improvements
Education and Certification Reimbursement
Machinery and Equipment
Other Employee Benefits
Professional Fees
Technical Services
Professional Services
Administrative Services
Education Services
Legal Services
Consultants
DRC
Safety
Utilities Expense
Custodial Expense
Repairs and Maintenance
Bldg Rental/Lease
Rental of Equipment or Vehicles
Field Trips
Telephone
Advertising and Marketing
Food Costs
Mileage Allowance
Travel
Temporarily Restricted Expenses
Materials and Supplies
Materials and Supplies Textbooks
Materials and Supplies Assessments
Materials and Supplies Curriculum
Materials and Supplies Writing
Books and Periodicals
Office Supplies
Equipment
Dues & Fees
Meals and Entertainment
Miscellaneous Expense
Bank Fees
Other Misc Business Expense
5
Building Improvements
Education and Certification Reimbursement
Machinery and Equipment
Other Employee Benefits
Professional Fees
Technical Services
Professional Services
Administrative Services
Education Services
Legal Services
Consultants
DRC
Safety
Utilities Expense
Custodial Expense
Repairs and Maintenance
Bldg Rental/Lease
Rental of Equipment or Vehicles
Field Trips
Telephone
Advertising and Marketing
Food Costs
Mileage Allowance
Travel
Temporarily Restricted Expenses
Materials and Supplies
Materials and Supplies Textbooks
Materials and Supplies Assessments
Materials and Supplies Curriculum
Materials and Supplies Writing
Books and Periodicals
Office Supplies
Equipment
Dues & Fees
Meals and Entertainment
Miscellaneous Expense
Bank Fees
Other Misc Business Expense
Taxes (Optional)
Total ($)
*
Employee Certification
I certify that the above information is accurate and that the purchase was made solely for school-related purposes. I understand that repeated failure to retain and submit receipts may result in disciplinary action or revocation of credit card privileges.
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